ANNEXURE – 1

PRESCRIBED APPLICATION FORMAT – TEACHING POSITIONS

Advt. No.: IIITP/T/ADV/R/2024/4403 Date: 08/02/2024

Application for the Post of

Affix
Coloured
Department
Passport Size
Photograph
Grade / Level signed across

Instructions:
Attach all Annexures as suggested. All Annexures (in A4 size) should be attached in spiral
bound form including this application (No Staples).

Category (A) : UR SC ST OBC EWS (tick one, as applicable)

(B) : PWD (tick, if applicable)

Fee Remittance:

Bank / Place DD / UTR No Date Amount (Rs.1000/- or Rs. 500/-)

1) Name (in Capital Letters) : __________________________________________________

Date of Birth : Sex: M F

D D M M Y Y Y Y

2) Address for Correspondence :

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Contact / Mobile No. : ______________________ Email ID : ________________________

Additional Mobile No.: _____________________

Signature of Applicant

Page 1 | 7
3) Areas of Specialization : i) _________________________ ii) ________________

iii)_________________________

4) Essential Qualification * :

Sr. % Marks/ Date University /

Qualification * Degree Division
No. CGPA Entry Completion Institution
1. Ph.D.

2. PG

3. UG

4. HSSC (12th) or
Diploma

5. SSC (10th)

* For additional qualification (e.g. double UG & PG Degree, Post Doctoral etc.)

5) Experience (As on ??-??-2024 – Please attach supporting documents)

A) Teaching Experience:

Name of Institution and Total

From To Pay Scale
Position Years

Signature of Applicant

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 B. Experience in Industries / Research Labs (National Only):

Total
Name of Industry/Lab From To Pay Scale
Years

C. Existing Emoluments: (Enclose relevant documents)

Basic Pay in Pay Band to total

OR

Basic Pay (USD) in Pay Band (USD) to (USD) total (USD)

6) Desirable Requirements:

Research Publications (Published / Accepted for Publication):

(Give the list of publications with citation index, impact factor. Enclose maximum 10 copies of the
most cited journal papers)

Listed under Web of Science Nos. Listed under Scopus Nos.

(Journals only options)

Signature of Applicant

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7) Subjects of interests, which you would like to teach -

A) At UG (B.Tech) Level: Core Courses

i) ______________________ ii) ______________________ iii) _______________

B) At UG (B.Tech) Level : Elective Courses

i) ______________________ ii) ______________________ iii) _______________

C) At PG/ Doctoral Level: Core Courses

i) ______________________ ii) ______________________ iii) ________________

D) At PG / Doctoral Level: Elective Courses

i) ______________________ ii) ______________________iii) ________________

8) Any other information:

Sr.
Particulars Applicant Feedback
No.

i Post Doctoral Research

ii Research Facilities Created

iii Books Published

iv Products Developed

vi PG Projects Guided

vi Patents

Note:- Use separate sheet, if required.

Signature of Applicant

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9) Give name, designation and address (Phone No /Mobile No/ Email) of three referees not
related to you. Reference should be of persons who have intimate knowledge of your work.

Sr. Department Address /

Name Designation
No. Phone / Email ID
1)

2)

3)

10) Vision Statement: Write a note on your Short Term and Long Term Goals:

Short Term Goals (Next Five Years):

a. Teaching:

b. Research:

Long Term Goals (Career):

a. Teaching:

b. Research:

Signature of Applicant

Page 5 | 7
11) Institute Level / Department level Responsibilities:

12) Elaborate how you can help IIITP to become one of the leading Institutes. Out of the
following, in which activity you can contribute and how?

Sr. Can you

Activity If Yes, How?
No. contribute? Y/N
1 General Administration,
Academic, Hostel Affairs,
Library Management,
Students Activities,
Permanent Campus
Development etc.
2 NBA/ NAAC, Consultancy,
Research and Revenue
Generation

13) Total Credit Points claimed as per Annexure – 2 - -----------------------------------------------

Signature of Applicant

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 DECLARATION

I hereby, solemnly declare that the information furnished in this application are true and correct to the
best of my knowledge and belief. If at any time I am found to have concealed/ suppressed any material/
information or have given any false details, my candidature/appointment shall be liable to be summarily
cancelled/ terminated without any notice or compensation.

Place :
Date : Signature of Applicant

- FOR OFFICE USE ONLY -

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 ANNEXURE – 2

PRESCRIBED FORMAT FOR DETAILS OF CREDIT POINTS

Advt. No.: IIITP/T/ADV/R/2024/4403 Date: 08/02/2024

Supporting
Sr. Credit Points
Activity (Please Tick as applicable) Document Ref.
No. Claimed
Page No.
One External Sponsored Research and PI Co-PI
1 Development Projects completed or
ongoing or Patent granted.
Single Group
2 Consultancy Projects
PhD Completed (including Thesis Sup Co-Sup
3
submitted Cases)
One Journal Papers in Science Citation 1st Auth. Co-Auth
4 Index (SCI) or Scopus (Paid Journals
not allowed)
One Conference paper indexed in 1st Auth. Co-Auth
Science Citation Index or Scopus or
5
Web of science Conference or any
internationally renowned conference
Head of the Department, Dean, Chief
Warden, Professor Incharge (Training
6 and Placement), Advisor (Estate), -- --
Chief Vigilance Officer, PI (Exam),
TEQIP (Coordinator)
Warden, Assistant wardens, Associate
Dean, Chairman or Convener institute
academic committees, Faculty In
charge Computer Center or
7 -- --
Information and Technology Services
or Library or Admission or student
activities and other Institutional
activities

Signature of the Applicant

 Supporting
Sr. Credit Points
Activity (Please Tick as applicable) Document Ref.
No. Claimed
Page No.
Chairman and Convener of different
standing committee and special
committee (Ex officio status will not
8 -- --
be considered). Faculty incharges
(Each for one year duration) of
different Units or equivalent
Departmental activities identified by
Head of the Department like lab in
9 charges, or department level -- --
committee for a minimum period of
one year.
Workshop or Faculty Development Single Group
Program or short term courses of min
10
05 working days duration offered as
coordinator or convener.
For conducting national programs like
Single Group
Global Initiative of Academic
11 Networks etc. as course coordinator:
Program of two weeks duration
Program of one week duration

National or International conference

12 -- --
organized as Chairman or Secretary.
Length of service over and above the
13 relevant minimum teaching experience
required for a given cadre.

14 Establishment of New Lab(s) -- --

Theory Teaching of over and above 6

15 -- --
credit hrs. course.

16 Post Graduate Dissertation guided -- --

17 Under Graduate Projects -- --

Text or Reference Books published on

18 relevant subjects from reputed -- --
international publishers.

Signature of the Applicant

 Supporting
Sr. Credit Points
Activity (Please Tick as applicable) Document Ref.
No. Claimed
Page No.
Text or Reference book published on
relevant subjects from reputed national
19 publishers or book chapters in the -- --
books published by reputed
international publishers.
Significant outreach Institute out
20 activities -- --

21 Fellow IEEE, FNA, FNAE, FNASc -- --

Placement percentage (only for the
placement cell officers or Faculty In-
charge of Placement):
Above 85%
22 -- --
75% - 84%
(% to be based on total number of
students passing out and single job
offer)

Total Credits Claimed =

Note: - The Candidate has to fill the credits and attach self-attested supporting documents and
specifically mention page numbers for ready reference.

PI – Principal Investigator / Co-PI – Co-Principal Investigator

Sup – Supervisor / Co-Sup – Co-Supervisor
1st Auth – 1st Author / Co-Auth – Co-Author

Signature of Applicant